• Clinical and Experimental Pediatrics
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• v.54 no.12
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• pp.481-488
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• 2011

In the current era of low-birth rate in Korea, it is important to improve our neonatal intensive care and to establish an integrative system including a regional care network adequate for both high-risk pregnancies and high-risk newborn infants. Therefore, official discussion for nation-wide augmentation, proper leveling, networking, and regionalization of neonatal and perinatal care is urgently needed. In this report, I describe the status of neonatal intensive care in Korea, as well as nationwide flow of transfer of high-risk newborn infants and pregnant women, and present a short review of the regionalization of neonatal and perinatal care in the Unites States and Japan. It is necessary not only to increase the number of neonatal intensive care unit (NICU) beds, medical resources and manpower, but also to create a strong network system with appropriate leveling of NICUs and regionalization. A systematic approach toward perinatal care, that includes both high-risk pregnancies and newborns with continuous support from the government, is also needed, which can be spearheaded through the establishment of an integrative advisory board to propel systematic care forward.

• Health Policy and Management
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• v.3 no.2
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• pp.27-80
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• 1993

It is widely known that patients' utilization pattern for medical care facilities and the patientflow are influenced by multi-factors, such as demographic characteristics, structural characteristics of society, socio-psychological characteristics(value, attitude, norms, culture, health behavior, etc.), economic characteristics(income, medical price, relative price, physician induced demand, etc.), geographical accessibility, systematic characteristics(health care delivery system, payment methods for physician fees, form of health care security, etc.), and characteristics of medical facilities(reliability, quality of medical care, convenience, kindness, tec.). This study was conducted to research the mechanism of patient-flow according to changes of health care system(implementation of national health insurance, health care referral system and regionalization of health care utilization, etc.) and characteristics of medical facilities(ownership of hospital, characteristics of medical services, non-medical characteristics, etc.). In this study, the fact could be ascertained that the patient-flow had been influenced by changes of health care system and characteristics of medical facilities.

• Journal of the Korean association of regional geographers
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• v.17 no.5
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• pp.617-637
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• 2011

This study employs qualitative approaches to examining geographical characteristics and patients' determinants of online referrals in terms of regionalization. In this light, I conducted interviews with 20 patients receiving online referrals in Choongbook, Korea, and investigated their behaviors regarding these referrals between July and August 2009. I found that many patients who suffered from various levels of illness preferred tertiary care centers outside of Choongbook and did not enjoy their experience with the local medical institutions as the online referral service sites. This result might be because patients choose online referrals for psychological considerations such as quality and level of health care services, personal stakes in online referral service sites, acceptability and credibility of good tertiary care centers, and easy access to and use of medical institutions. Meanwhile, immediate benefits with regard to the technological value of online referrals, such as convenience, utility, and original purpose associated with regionalization, did not influence patients' decision-making. Therefore, the social and public networks affiliated with online referrals plus the effect of Korean medical laws play hostage to private decisions made by citizens, who prefer high-level medical institutions. Accordingly, the technological contribution of online referrals does not halt the outflow of patients from local, tertiary care centers. Especially, the existing health care system and patients' behaviors are deeply related to referrals in the online system. To protect regionalization, the improvement of health care services from the present state of affairs is required.

• Journal of Preventive Medicine and Public Health
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• v.23 no.3 s.31
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• pp.285-295
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• 1990

The utilization of medical care services has been partly regionalized with the implementation of referral requirement by the government since July 1, 1989 when the health insurance coverage was extended to all the people. For the purpose of regionalization, the whole country has been primarily divided into tertiary care regions, and each of them again into secondary care regions. This study investigates the self-sufficiency for in-patient care services of secondary care regions focusing on why it varies among the regions. In doing so, analysis is performed to examine a model which embodies three sets of hypotheses as follows : 1) The regional self-sufficiency for medical care services would be subject to direct influences of regional characteristics, amount of available services and structural properties of regional medical care system ; 2) The regional characteristics would have indirect effects on the self-sufficiency which are mediated by medical care services ; and 3) The amount of available services would indirectly affect the self-sufficiency by influencing the structure of regional medical care system. The results of analysis were generally consistent with the model. The findings have some practical implications. The regional self-sufficiency for medical care services partly depends upon basic properties of each region which cannot be changed in a short period of time. Thus the self-sufficiency for medical care services can be improved mainly by health policy measures. In some of the regions the self-sufficiency for in-patient care services was much higher or lower than can be predicted from the bed-population ratio. Indication is that the allocation of health resources should be made considering a variety of factors bearing upon the supply of and demand for health care ; not on the basis of just a single criterion like the availability. The self-sufficiency of a certain region is related to not only its own characterstics but also the characteristics of neighboring regions. Therefore, attention should be also directed to the inter-regional relationships in health care when the needs for investment of health resources in a region are assessed. However, it should be noted that this study used the data collected before the referral requirement was imposed. A replication of this analysis using recent data would provide an evaluation of the impact on the self-sufficiency of the referral requirement as well as a confirmation of the findings of this study.

• Health Policy and Management
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• v.18 no.4
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• pp.66-84
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• 2008

Objectives: This study aimed to. offer some fundamental evidences for the stroke management policy by investigating the trends of medical care utilization and regionalization in stroke inpatients. Methods: We used the National Health Insurance claims and registry data for stroke inpatients from 1998 to 2005. Among all stroke inpatient claims data, self-employed insured and their dependents were only included in this study. The classification of stroke was based on ICD-10(I60-I69) and its subtype was divided by hemorrhage(I60-I62) and infarction(I63-I64) type. To evaluate regionalization of medical care utilization, relevance index was calculated by regions. The regions were classified 8 large catchment areas and 163 self authorized areas. Results: The overall medical care utilization rate of stroke inpatient has been increased, especially infarction subtype. Among medical care institutions, the utilization of hospital has been the most rapidly increased. Although considered annual rate of interest, total medical cost of stroke inpatients has been increased, Totally, more than 84% of stroke inpatient were admitted to medical care institutions in their own large catchment area during 1998-2005. The relevance indices in their own large catchment area (self sufficiency rates) were more than 70% in most areas regardless of stroke subtype except Chungbuk catchment area. Self sufficiency rates of stroke inpatients among 163 self authorized areas in 1998 and 2005 were 84.2% and 83.1% in metropolitan, 46.7% and 45.5% in urban, and 19.5% and 22.6% in rural areas, respectively. Conclusion: Stroke management policy for improvement of distribution at the district level, especially in rural areas, may be helpful for reducing regional inequality in stroke.

• Health Policy and Management
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• v.2 no.2
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• pp.1-32
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• 1992

The Canadian experience-universal government health insurance administeredby the ten provinces and two territories with some fiscal and policy variations-suggests the possibility of more effectve and efficient health care delivery system. The central purpose of the Canadian health in surance was to reduce and hopefully eliminate financial barriers to medical care. In this it succeeded. But it also produced varous kinds of unexpected side-effects on cost and quality. The Federal and Provincial Governments of Canada continue to exert theri efforts to ameliorate these problems. The lesson from Canada is that the health care revenue should be raised at the national level and managed at the regional level, and the regional healthcare financing organization has to take over the functions of the public health center. These alternatives is expected to make the Korean health care delivery system more efective and efficient, and to achieve health for all. This paper also discussed the policy agenda for implementing such alternatives in Korea.

• Journal of the Korean Geographical Society
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• v.46 no.4
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• pp.501-517
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• 2011

This research investigates a geographical issue as to which factor discovered in the only Japanese telemedicine with regard to social and medical circumstances performs a role as a determinant in regionalization, especially, local areas in Japan. According to the results, strong human networks based on regionalism are mirrored in regionalization and are associated with not only the development and management of telemedicine operations, but also the choice of telemedicine users concretely. In other words, all processes from the suggestion stage of telemedicine to the practical usage or application stage of telemedicine are involved in the existing human networks within one prefecture (the third diagnostic area); further, personal stakes are transferred to public health care services (telemedicine) and their relationships have been formulated by the telemedicine council including local government, medical association, region-rooted companies, core health centers and universities, etc. Accordingly, the telemedicine council responses to the need of telemedicine users immediately and contributes to develop regional health care. Also, telemedicine users have been connected with each other closely before operating telemedicine; accordingly, the human relationships between doctors and patients or among doctors influence the choice of telemedicine serving sites and their behaviors comes down to regional-based diagnosis via the telemedicine system.

• Journal of Preventive Medicine and Public Health
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• v.55 no.1
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• pp.49-59
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• 2022

Objectives: Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran. Methods: First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties. Results: It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider. Conclusions: This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.

• Journal of Microbiology and Biotechnology
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• v.30 no.7
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• pp.962-966
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• 2020

Monitoring the mutation dynamics of human severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical in understanding its infectivity, virulence and pathogenicity for development of a vaccine. In an "age of mobility," the pandemic highlights the importance and vulnerability of regionalization and labor market interdependence in Southeast Asia. We intend to characterize the genetic variability of viral populations within the region to provide preliminary information for regional surveillance in the future. By analyzing 142 complete genomes from South East Asian (SEA) countries, we identified three central variants distinguished by nucleotide and amino acid changes.

• Journal of Preventive Medicine and Public Health
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• v.21 no.2 s.24
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• pp.390-403
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• 1988

The objectives of the study were to provide the basic informations needed in the development of balanced medical services throughout the nation. As the national health care system was expanding rapidly along with the economic growth, quantitative re-evaluation of the system is of great need. For that reason, characteristics of the admitted patients were analyzed for the case-mix and patients' flow within and through regions. Materials were 421,530 cases of inpatients, who were reported through Korea Medical Insurance Corporation(KMIC) for insurance claim, during the period of March 1, 1985 through February 28, 1987. Korean Diagnosis Related Groups(K-DRGs) classification system was adopted for the study of case-mix and 189 cities and counties were classified into 5 district groups by factor analysis results of K-DRGS. The major findings of this study were as follows ; 1) Factor analysis of case-mix, employing K-DRG system, revealed 5 distinct funtional district groups. Group A(18 districts) was prominent for tertiary medical care. In group B(36 districts), rather simple procedures were prevalent. Group C(26 districts) was distinctive for the medical care of well organized internal medicine practices with qualified clinical laboratories. Group D(17 districts) was characterized by relatively high balanced medical care. Group E (92 districts) was with very low level of medical care. 2) Analysis of the case-flow through the districts showed 3 types of flow patterns : inflow, outflow, and balanced types. Inflow type of case-flow was found in Group A, C and D while Group B and E showed outflow type. Inflow was most prominent in Group A and Group E was of typical outflow type. Group B was consistently the outflow type except for Major Diagnostic Category XX regardless of the disease treaters, but Group C and D were inflow or outflow types according to the disease tracers.